Geographical and Specialty-specific Variation in the Utilization of Laminoplasty for Cervical Myelopathy

Study Design: Level IV retrospective cohort study. Objectives: Despite the positive outcomes associated with laminoplasty, there is significant surgeon variability in the use of laminoplasty for cervical myelopathy in the United States. In this study, we explored how geographic and specialty-specific differences may influence the utilization of laminoplasty to treat cervical myelopathy. Background: We queried the Mariner 157 database (PearlDiver, Inc.), a national administrative claims database containing diagnostic, procedural, and demographic records from over 157 million patients from 2010 to 2021. Patients and Methods: Using the International Classification of Diseases 10th Revision/International Classification of Diseases Ninth Revision and Current Procedural Terminology codes, we identified all patients with a diagnosis of cervical myelopathy who had undergone multilevel posterior cervical decompression and fusion (PCDF) or laminoplasty. We further analyzed patients' demographics, comorbidities, geographical location, and specialty of the surgeon (neurosurgery or orthopedic spine surgery). Results: There were 34,432 patients with a diagnosis of cervical myelopathy, of which 4,033 (11.7%) underwent laminoplasty and 30,399 (88.3%) underwent multilevel PCDF. Northeast, South, and West regions had lower percentages of laminoplasty utilization compared with the Midwest in terms of total case mix between laminoplasty and PCDF. In addition, 2,300 (57.0%) of the laminoplasty cases were performed by orthopedic spine surgeons compared with 1,733 (43.0%) by neurosurgeons. Temporal trends in laminoplasty utilization were stable for orthopedic surgeons, whereas laminoplasty utilization decreased over time between 2010 and 2021 for neurosurgeons (P < 0.001). Conclusions: Utilization of laminoplasty in the United States is not well defined. Our results suggest a geographical and training-specific variation in the utilization of laminoplasty. Surgeons with orthopedic training were more likely to perform laminoplasty compared with surgeons with a neurosurgery training background. In addition, we found greater utilization of laminoplasty in the Midwest compared with other regions.